Methods and compositions for diagnosis and treatment of B cell chronic lymphocytic leukemia

ABSTRACT

Provided are isolated and purified preparations of a combination of a light chain antibody gene and a heavy chain antibody gene, where the light chain and heavy chain antibody genes are the same among more than one patient with B cell chronic lymphocytic leukemia (B-CLL). Vectors comprising those genes and cells comprising those vectors are also provided, as are isolated and purified antibodies encoded by the antibody genes. Anti-idiotype antibodies, peptides, and aptamers that bind to the antigen-binding region of an antibody encoded by the antibody genes are additionally provided, as are multimeric molecules comprising multiple binding sites that bind to the antigen-binding region of an antibody encoded by the antibody genes. Methods of determining whether a patient with B cell chronic lymphocytic leukemia (B-CLL) has a form of B-CLL that is susceptible to treatment directed to eliminating idiotype specific B cell receptor-bearing B-CLL cells are also provided, as are methods of following the progression of treatment of B-CLL in the patient. Additionally, methods of treating a patient having B-CLL are provided, as are methods of identifying a therapeutic agent for B-CLL.

CROSS-REFERENCE TO RELATED APPLICATION

This is a U.S. National Phase of PCT Application No. PCT/US2004/033176,filed Oct. 8, 2004, which claims the benefit of U.S. ProvisionalApplication No. 60/509,473, filed Oct. 8, 2003.

STATEMENT REGARDING FEDERALLY FUNDED RESEARCH OR DEVELOPMENT

The invention was made with government support under Grants No. CA 81554and CA 87956 awarded by the National Institutes of Health. Thegovernment has certain rights in this invention.

BACKGROUND

The present invention generally relates to methods of diagnosis andtreatment of B cell chronic lymphocytic leukemia (B-CLL). Moreparticularly, the invention relates to methods of B-CLL diagnosis andtreatment based on the presence of sets of B-CLL patients that have Bcell receptor genes in common.

DESCRIPTION OF THE RELATED ART References Cited

-   Bendelac, A., M. Bonneville, and J. F. Kearney. Autoreactivity by    design: innate B and T lymphocytes. Nat Rev Immunol. 2001:1:177-186.-   Borche L et al. Blood 1990; 76:562-569.-   Brezinschek H P, Foster S J, Brezinschek R I, Dorner T, Domiati-Saad    R, Lipsky P E. Analysis of the human VH gene repertoire.    Differential effects of selection and somatic hypermutation on human    peripheral CD5(+)/IgM+ and CD5(−)/IgM+B cells. J Clin Invest. 1997;    99:2488-2501.-   Broker B M et al. J Autoimmun 1988; 1:469-481.-   Casali P, Schettino E W. Structure and function of natural    antibodies. Current Topics in Microbiology & Immunology. 1996;    210:167-179.-   Chapman C J, Spellerberg M B, Smith G A, Carter S J, Hamblin T J,    Stevenson F K. Autoanti-red cell antibodies synthesized by patients    with infectious mononucleosis utilize the VH4-21 gene segment.    Journal of Immunology 1993; 151:1051-1061.-   Chiorazzi, N., and M. Ferrarini. Immunoglobulin Variable Region Gene    Characteristics and Surface Membrane Phenotype Define B-CLL    Subgroups with Distinct Clinical Courses. In Chronic Lyniphoid    Leukemias. B. D. Cheson, editor. Marcel Dekker, New York. 2001;    81-109.-   Chiorazzi, N., and M. Ferrarini. B Cell Chronic Lymphocytic    Leukemia: Lessons Learned from Studies of the B Cell Antigen    Receptor. In Annual Review of Immunology. W. E. Paul, editor. 2003;    21:841-894.-   Damle, R. N., T. Wasil, F. Fais, F. Ghiotto, A. Valetto, S. L.    Allen, A. Buchbinder, D. Budman, K. Dittmar, J. Kolitz, S. M.    Lichtman, P. Schulman, V. P. Vinciguerra, K. R. Rai, M. Ferrarini,    and N. Chiorazzi. Ig V gene mutation status and CD38 expression as    novel prognostic indicators in chronic lymphocytic leukemia. Blood.    1999; 94:1840-1847.-   Fais F, Ghiotto F, Hashimoto S, Sellars B, Valetto A, Allen S L,    Schulman P, Vinciguerra V P, Rai K, Rassenti L Z, Kipps T J,    Dighiero G, Schroeder H W, Jr., Ferrarini M, Chiorazzi N. Chronic    lymphocytic leukemia B cells express restricted sets of mutated and    unmutated antigen receptors. J Clin Invest. 1998; 102:1515-1525.-   Fais, F., G. Gaidano, D. Capello, A. Gloghini, F. Ghiotto, S.    Roncella, A. Carbone, N. Chiorazzi, and M. Ferrarini. Immunoglobulin    V region gene use and structure suggest antigen selection in    AIDS-related primary effusion lymphomas. Leukemia 1999;    13:1093-1099.-   Geiger, K. D., U. Klein, A. Brauninger, S. Berger, K. Leder, K.    Rajewsky, M. L.-   Hansmann, and R. Kuppers. CD5-positive B cells in healthy elderly    humans are a polyclonal B cell population. Eur J Immunol. 2000;    30:2918-2923.-   Ghia, P., G. Prato, C. Scielzo, S. Stella, M. Geuna, G. Guida,    and F. Caligaris-Cappio. Monoclonal CD5+ and CD5− B-lymphocyte    expansions are frequent in the peripheral blood of the elderly.    Blood. 2004; 103:2337-2342.-   Ghiotto, F., F. Fais, A. Valetto, E. Albesiano, S. Hashimoto, M.    Dono, H. Ikematsu, S. L. Allen, K. R. Rai, M. Nardinii, A.    Tramontano, M. Ferrarini, and N. Chiorazzi. Remarkable similar    antigen receptors among a subset of patients with chronic    lymphocytic leukemia. J Clin Invest. 2004; 113:1008-1016.-   Hamblin, T. J., Z. Davis, A. Gardiner, D. G. Oscier, and F. K.    Stevenson. Unmutated Ig V(H) genes are associated with a more    aggressive form of chronic lymphocytic leukemia. Blood. 1999;    94:1848-1854.-   Hashimoto, S., M. Wakai, J. Silver, and N. Chiorazzi. Ann. NY. Acad.    Sci. 1992; 651:477-479.-   He X, Goronzy J J, Zhong W, xie C, Weyand C M. VH3-21 B cells escape    from a state of tolerance in rheumatoid arthritis and secrete    rheumatoid factor. Mol Med. 1995; 1:768-780.-   Isaacson, P. G. Gastric MALT lymphoma: from concept to cure. Ann    Oncol. 1999; 10:637-645.-   Jahn S, Schwab J, Hansen A, Heider H, Schroeder C, Lukowsky A,    Achtman M, Matthes H, Kiessig S T, Volk H D. Human hybridomas    derived from CD5+ B lymphocytes of patients with chronic lymphocytic    leukernia (B-CLL) produce multi-specific natural IgM (kappa)    antibodies. Clin Exp Immunol. 1991; 83:413-417.-   Johnson T A, Rassenti L Z, Kipps T J. Ig VH1 genes expressed in B    cell chronic lymphocytic leukermia exhibit distinctive molecular    features. J mnunol. 1997; 158:235-246.-   Kirkham, P. M., F. Mortari, J. A. Newton, and H. W. Schroeder, Jr.    EMBO. J. 1997; 11:603-609.-   Kipps T J, Tomhave E, Pratt L F, Duffy S, Chen P P, Carson D A.    Developmentally restricted immunoglobulin heavy chain variable    region gene expressed at high frequency in chronic lymphocytic    leukemia. Proc Natl Acad Sci USA. 1989; 86:5913-5917.-   Kumar, S., S. Nagl, J. K. Kalsi, C. T. Ravirajan, D. Athwal, D. S.    Latchman, L. H. Pearl, and D. A. Isenberg. Anti-cardiolipin/beta-2    glycoprotein activities co-exist on human anti-DNA antibody light    chains. Mol Immunol. 2003; 40:517-530.-   Mann, D. L., P. DeSantis, G. Mark, A. Pfeifer, M. Newman, N.    Gibbs, M. Popovic, M. G.-   Sarngadliaran, R. C. Gallo, J. Clark, and et al. HTLV-I-associated    B-cell CLL: indirect role for retrovirus in leukemogenesis. Science.    1987; 236: 1103-1106.-   Martin, F., and J. F. Kearney. B-cell subsets and the mature    preimmune repertoire. Marginal zone and B1 B cells as part of a    “natural immune memory”. Immunol Rev. 2000; 175:70-79.-   Pascual, V., K. Victor, M. Spellerberg, T. J. Hamblin, F. K.    Stevenson, and J. D. Capra. VH restriction among human cold    agglutinins. The VH4-21 gene segment is required to encode anti-I    and anti-i specificities. J. Immunol. 1992; 149:2337-2344.-   Potter, M. Antigen-binding myeloma proteins of mice. Adv Immunol.    1977; 25: 141-211.-   Pugh-Bernard A E, Silverman G J, Cappione A J, Villano M E, Ryan D    H, Insel R A, Sanz I. Regulation of inherently autoreactive VH4-34 B    cells in the maintenance of human B cell tolerance. The Journal of    Clinical Investigation. 2001; 108:1061-1070.-   Radic, M. Z., and M. Weigert. Genetic and structural evidence for    antigen selection of anti-DNA antibodies. Annu Rev Immunol. 1994;    12:487-520.-   Rawstron, A. C., M. J. Green, A. Kuzrnicki, B. Kennedy, J. A.    Fenton, P. A. Evans, S. J. O'Connor, S. J. Richards, G. J.    Morgan, A. S. Jack, and P. Hillmen. Monoclonal B lymphocytes with    the characteristics of “indolent” chronic lymphocytic leukemia are    present in 3.5% of adults with normal blood counts. Blood. 2002;    100:635-639.-   Schroeder H W J, Dighiero G. The pathogenesis of chronic lymphocytic    leukemia: analysis of the antibody repertoire [see comments].    Immunol Today. 1994; 15:288-294.-   Scott, M. G., D. L. Crimmins, D. W. McCourt, I. Zocher, R.    Thiebe, H. G. Zachau, and M. H. Nahm. Clonal characterization of the    human IgG antibody repertoire to Haemophilus influenzae type b    polysaccharide. III. A single VKII gene and one of several JK genes    are joined by an invariant arginine to form the most common L chain    V region. J. Immunol. 1989; 143:4110-4116.-   Seidl, K. J., J. D. MacKenzie, D. Wang, A. B. Kantor, E. A. Kabat,    and L. A. Herzenberg. Frequent occurrence of identical heavy and    light chain Ig rearrangements. Int Immunol. 1997; 9:689-702.-   Silverman, G. J., R. D. Goldfien, P. Chen, R. A. Mageed, R.    Jefferis, F. Goni, B. Frangione, S. Fong, and D. A. Carson.    Idiotypic and subgroup analysis of human monoclonal rheumatoid    factors. Implications for structural and genetic basis of    autoantibodies in Jiumans. J Clin Invest. 1988; 82:469-475.-   Smith G, Spellerberg M, Boulton F, Roelcke D, Stevenson F. The    immunoglobulin VH gene, VH4-21, specifically encodes autoanti-red    cell antibodies against the I or i antigens. Vox Sang. 1995;    68:231-235.-   Stevenson F K, Spellerberg M B, Chapman C J, Hamblin T J.    Differential usage of an autoantibody-associated VH gene, VH4-21, by    human B-cell tumors. Leukemia & Lymphoma. 1995; 16:379-384.-   Sthoeger, Z. M., M. Wakai, D. B. Tse, V. P. Vinciguerra, S. L.    Allen, D. R. Budman, S. M. Lichtman, P. Schulman, L. R. Weiselberg,    and N. Chiorazzi. Production of autoantibodies by CD5-expressing B    lymphocytes from patients with chronic lymphocytic leukemia. J Exp    Med. 1989; 169:255-268.-   Sthoeger Z M et al. Am J Hematol 1993; 43:259-264.-   Tobin, G., U. Thunberg, A. Johnson, I. Thorn, O. Soderberg, M.    Hultdin, J. Botling, G. Enblad, J. Sallstrom, C. Sundstrom, G. Roos,    and R. Rosenquist. Somatically mutated Ig V(H)3-21 genes    characterize a new subset of chronic lymphocytic leukemia. Blood.    2002; 99:2262-2264.-   Tobin G. et al. Blood 2003; 101:4952-4957.-   Wakai M, Hashimoto S, Omata M, Sthoeger Z M, Allen S L, Lichtman S    M, Schulman P, Vinciguerra V P, Diamond B, Dono M, et al. IgG+, CD5+    human chronic lymphocytic leukemia B cells. Production of IgG    antibodies that exhibit diminished autoreactivity and IgG subclass    skewing. Autoimmunity. 1994; 19:3948.-   Zemlin, M., M. Klinger, J. Link, C. Zemlin, K. Bauer, J. A.    Engler, H. W. Schroeder, Jr., and P. M. Kirkham. Expressed murine    and human CDR-H3 intervals of equal length exhibit distinct    repertoires that differ in their amino acid composition and    predicted range of structures. J Mol Biol. 2003; 334:733-749.

B cell chronic lymphocytic leukemia (B-CLL) is an accumulative diseaseof slowly proliferating CD5⁺ B lymphocytes that develops in the agingpopulation. Whereas some patients with B-CLL have an indolent course anddie after many years from unrelated causes, others progress very rapidlyand succumb within a few years from this currently incurable leukemia.Over the past decade, studies of the structure and function of the Bcell antigen receptor (BCR) used by these leukemic cells have helpedredefine the nature of this disease.

CD5⁺ B lymphocytes in B-CLL patients express low levels of surfacemembrane Ig that serves as their receptor for antigen (BCR). Thegenetics of this Ig have clinical relevance, as patients with an Ig thatis unmutated in the variable (V) regions have a significantly worseoutcome than those with significant numbers of mutations in the Ig Vregion. The biological basis by which the Ig molecule/BCR associateswith these distinct outcomes is unclear.

There are several lines of evidence supporting a role for the Igmolecule in the evolution of B-CLL. Analysis of V region gene cassetteusage has provided inferential evidence that the Ig molecules on B-CLLcells are not the product of random chance. The distribution of variableregion gene cassettes used by B-CLL clones (Schroeder and Dighiero,1994) differs from that found in normal cells (Brezinschek et al., 1997)with an increased frequency of V_(H) 3-07, V_(H) 4-34, and V_(H) 1-69genes (Fais et al., 1998). Furthermore, the distribution of mutationsamong B-CLL cases using these specific V_(H) genes is selectively andstrikingly biased. For instance, the V_(H) genes of ˜40% of B-CLL casescontain <2% differences from the most similar germline gene and ˜25% areidentical to a germline V_(H) counterpart. However, 80% of the casesthat use a V_(H) 1-69 are germline and ˜90% of these have less than 2%mutation. Conversely, in 93% of cases the V_(H) 3-07 gene exhibitssignificant numbers of mutations (22% difference from the germlinegene). These deviations from randomness in gene use and acquisition ofsomatic mutations imply that the structure of the antibody molecule, andpossibly its antigen specificity thus manifest, played a role in theleukemic transformation of particular B cells.

More recently, sets of B-CLL cases with highly similar Ig molecules havebeen identified. Our laboratory identified five unmutated IgG-expressingB-CLL cases in which the BCR was remarkably similar in structure(Ghiotto et al. 2003). These Ig molecules used the same V_(H), D, J_(H),and in all but one instance the same V_(K)-J_(K). Furthermore, theHCDR3s were highly similar in sequence and the LCDR3s were virtuallyidentical with a V_(K)-J_(K) junction contained an invariant,non-templated arginine codon. A larger set of patients expressing aV_(H)3-21/J_(H)3H chain and a Vλ-3h/Jλ3 L chain have been described byTobin et al. (2003). These cases also have a HCDR3 that is small and ofvery similar sequence. The VH3-21 gene is not found at high frequencyoutside of northern Europe, suggesting an environmental or geneticinfluence. The patients from both of these groups have a poor clinicalcourse that does not necessarily relate to their VH mutation status.

Functional studies have shown that patients with unmutated Ig V regionscan transduce signals through the B cell receptor (BCR), while themutated BCR cannot. This finding could have major significance since itprovides a means by which antigen binding to the BCR might affect thebiology of the leukemic cells in vivo. This is especially relevant sincemany B-CLL cases synthesize autoreactive Ig/BCR molecules (Broker etal., 1988; Borche et al., 1990; Sthoeger et al., 1993) and/or use VHgenes that are often found in autoantibodies (Fais et al., 1998). Thisis consistent with the derivation of the leukemic cells from CD5⁺B-cells that in normal individuals are considered the primary source ofnatural antibodies (Casali and Schettino, 1996).

Despite recent identification of several biomarkers associated withoutcome in B-CLL, there is a need for additional prognostic indicatorsfor this disease. Also, there is a long-standing need for therapeutictargets and new therapeutic modalities in B-CLL, for which there is nogenerally accepted and specific curative regimen. The present inventionaddresses these needs.

SUMMARY OF THE INVENTION

Accordingly, the inventors have discovered that the B-CLL cells of asignificant proportion of B-CLL patients with an aggressive form of thedisease share the same classes of V_(H), D, J_(H), V_(L), and J_(L)antibody genes as other B-CLL patients, forming “sets” of B-CLL patientswith highly homologous B cell receptors. This discovery makes practicalvarious therapeutic and diagnostic methods.

Thus, in some embodiments, the invention is directed to isolated andpurified preparations of a combination of a light chain antibody geneand a heavy chain antibody gene. In these preparations, the familymembers of the light chain antibody gene and the heavy chain antibodygene are selected from the group consisting ofV_(H)4-39/D6-13/J_(H)5/V_(L)κO12/2/J_(L)κ1/κ2 (Set I),V_(H)4-34/D5-5/J_(H)6/V_(L)κA17/J_(L)κ1/κ2 (Set II),V_(H)3-21/J_(H)6/V_(L)λ3h/J_(L)λ3 (Set III),V_(H)1-69/D3-16/J_(H)31V_(L)κA27/J_(L)κ1/λ4 (Set IV), V_(H)¹-69/D3-10/J_(H)6/V_(L)λc/J_(L)λ1 (Set V),V_(H)1-02/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (Set VIa),V_(H)1-03/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (Set VIb),V_(H)1-18/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1 (Set VIc),V_(H)1-46/D6-19/J_(H)4 (Set VId),V_(H)5-51/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ2(Set VIe),V_(H)1-69/D3-3/J_(H)4/V_(L)κA19/J_(L)κ4 (Set VII), andV_(H)1-69/D2-2/J_(H)6/V_(LκL)6/2/J_(L)κ3 (Set VII).

The invention is also directed to cells in culture comprising at leastone vector comprising antibody genes from Set I, Set II, Set III, SetIV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, or SetVIII.

In other embodiments, the invention is directed to isolated and purifiedantibodies encoded by antibody genes from Set I, Set II, Set III, SetIV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, or SetVIII.

In further embodiments, the invention is directed to anti-idiotypeantibodies that bind to the antigen-binding region of an antibodyencoded by antibody genes from Set I, Set II, Set III, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, or Set VIII.

The invention is additionally directed to hybridomas expressing any ofthe above-described antibodies.

In related embodiments, the invention is directed to bispecificantibodies comprising the binding site of the above-describedanti-idiotype antibodies and a binding site that binds to another B-cellantigen.

The present invention is additionally directed to peptide antigens thatbind to the antigen-binding region of an antibody encoded by antibodygenes of Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, SetVIc, Set VId, Set VIe, Set VIf, or Set VIII.

In further embodiments, the invention is directed to aptamers that bindto the antigen-binding region of an antibody encoded by antibody genesof Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, SetVId, Set VIe, Set VII, or Set VIII.

The present invention is also directed to multimeric moleculescomprising at least a first and a second binding site. In theseembodiments, the first binding site binds to the antigen-binding regionof an antibody encoded by antibody genes of Set I, Set II, Set m, SetIV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, or SetVIII, and the second binding site binds to either (a) theantigen-binding region of an antibody encoded by antibody genes of SetI, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId,Set VIe, Set VII, or Set VIII or (b) a B-cell antigen.

The invention is additionally directed to isolated and purifiedpreparations of a combination of a light chain antibody gene and a heavychain antibody gene. In these embodiments, the gene family members ofthe light chain antibody gene and the heavy chain antibody gene arepresent in B cells of two or more patients, and the antibody chains ofthe B cells also share the same isotype, JH, D and JL regions, and the Bcells are lymphoproliferative in the patient, or the patient has anautoimmune disease involving the B cells.

In other embodiments, the invention is directed to methods ofdetermining whether a patient with B cell chronic lymphocytic leukemia(B-CLL) has a form of B-CLL that is susceptible to treatment directed toeliminating idiotype-specific B cell receptor-bearing B-CLL cells. Themethod comprises determining whether the B cell receptors on thepatient's B-CLL cells have an idiotype encoded by antibody genes fromSet I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, SetVId, Set VIe, Set VII, or Set VIII.

In related embodiments, the present invention is directed to methods offollowing the progression of treatment of B-CLL in the patientidentified by the above-described method as having a form of B-CLLsusceptible to treatment directed to eliminating idiotype-specific Bcell receptor-bearing B-CLL cells. The methods comprise determiningwhether the B cell receptors on the B-CLL cells have an idiotype encodedby antibody genes from Set I, Set II, Set III, Set IV, Set V, Set VIa,Set VIb, Set VIc, Set VId, Set VIe, Set VII, or Set VIII.

In further embodiments, the invention is directed to methods of treatinga patient having B-CLL, where the B-CLL is caused by B cells comprisingantibody genes from Set I, Set II, Set III, Set TV, Set V, Set VIa, SetVIb, Set VIc, Set VId or Set VIe, Set VII, or Set VIII. The methodscomprise administering to the patient any of the anti-idiotypeantibodies, peptide antigens, or aptamers described above, or mixturesthereof.

In additional embodiments, the invention is directed to methods ofidentifying a B-CLL set. The methods comprise identifying the VH, D, JH,VL, and JL antibody gene families present on B-CLL cells, where the sameantibody gene families are all present in more than one B-CLL patient.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 provides VH, D and JH regions of antibody genes from B-CLL cellsof Sets I-VIe. In FIG. 1-1, the germline sequences along the top are SEQID NO:1 and 2 (V_(H)4-39), SEQ ID NO:3 and 4 (D6-13) and SEQ ID NO:5 and6 (J_(H)5). The sequences of the individuals in FIG. 1-1, from top tobottom, are SEQ ID NO:7-18, respectively. In FIG. 1-2, the germlinesequences along the top are SEQ ID NO:19 and 20 (V_(H)4-34), SEQ IDNO:21 and 22 (D5-5) and SEQ ID NO:23 (J_(H)6 DNA sequence). Thesequences of the individuals in FIG. 1-2, from top to bottom, are SEQ IDNO:24-33, respectively. In FIG. 1-3, the germline sequences along thetop are SEQ ID NO:34 and 35 (V_(H)1-02), SEQ ID NO:36 and 37 (D6-19) andSEQ ID NO:38 and 39 (J_(H)4). The sequences of the individuals in FIG.1-3, from top to bottom, are SEQ ID NO:40-53, respectively. In FIG. 1-4,the germline sequences along the top are SEQ ID NO:34 and 35(V_(H)1-03), SEQ ID NO:55 and 56 (D6-19) and SEQ ID NO:38 and 39(J_(H)4). The sequences of the individuals in FIG. 1-4, from top tobottom, are SEQ ID NO:57-74, respectively. In FIG. 1-5, the germlinesequences along the top are SEQ ID NO:34 and 35 (V_(H)1-69), SEQ IDNO:75 and 76 (D3-16) and SEQ ID NO:77 and 78 (J_(H)3). The sequences ofthe individuals in FIG. 1-5, from top to bottom, are SEQ ID NO:79-88,respectively. In FIG. 1-6, the germline sequences along the top are SEQID NO:34 and 35 (V_(H)1-69), SEQ ID NO:89 and 90 (D3-10) and SEQ IDNO:91 (J_(H)5 DNA). The sequences of the individuals in FIG. 1-6, fromtop to bottom, are SEQ ID NO:92-99, respectively. In FIG. 1-7, thegermline sequences along the top are SEQ ID NO:34 and 35 (V_(E)3-21) andSEQ ID NO:100 and 101 (J_(H)6). The sequences of the individuals in FIG.1-7, from top to bottom, are SEQ ID NO:100-115, respectively. In FIG.1-8, the germline sequences along the top are SEQ ID NO:1 and 2(V_(H)5-51), SEQ ID NO:36 and 37 (D6-19) and SEQ ID NO:38 and 39(J_(H)4). The sequences of the individuals in FIG. 1-8, from top tobottom, are SEQ ID NO:116-128, respectively. In FIG. 1-9, the germlinesequences along the top are SEQ ID NO:34 and 35 (V_(H)1-02), SEQ IDNO:36 and 37 (D6-19) and SEQ ID NO:54 (J_(H)4 DNA). The sequences of theindividuals in FIG. 1-9, from top to bottom, are SEQ ID NO:40-53 and129-159, respectively.

FIG. 2 shows amino acid alignments of the H chain V regions of allsequences in Sets II, IV, V, VIa-e, and VIII. A period indicateshomology with the germline gene. Amino acids in gray are chemicallysimilar to the germline-encoded residues. Underlined positions are knownsites of allelic polymorphism. The consensus sequence for the set isshown at the bottom of each alignment. The sequences, from top tobottom, are SEQ ID NO:160-220, respectively.

FIG. 3 shows amino acid alignments of the L chain variable regions ofall sequences in Sets II, IV, V, VI, and VIII. See FIG. 2 descriptionabove. The sequences, from top to bottom, are SEQ ID NO:221, 222, 221,223, 221, 224-231, 230, 232, 231, 233-236, 236, 237, 236, 233, 236, 239and 236, respectively.

FIG. 4 shows amino acid and nucleotide sequences of the CDR3 and itsjunctions of set IV. The H chain sequences are shown at left, and the Lchain sequences are shown at right. The most similar germline genes areshown at top. Dots indicate homology with the germline sequence. Dashesindicate no sequence at that position. The numbering at bottom is forconvenience of reference and is arbitrary. Sequences from the publicdatabases have their GenBank accession number in parenthesis below thecase ID. Distinctive junctional residues exist, including a pair of Gcodons at the VH-D junction and an N codon at the D-JH junction. Thecreation of the G codon at the VH-D junction required trimming of the 3′adenosine nucleotide at the end of IgVH, along with N addition. Also,limited trimming at the 5′ end of the D segment eliminated the first ofthe pair of Y codons in all cases. In two instances, D replaced Y and intwo other cases N does the same; both of these are charged residues thatfit at the negative end of the Kyte-Doolittle scale. The Y codon at the3′ end of the D gene was also eliminated in all sequences of this set.Collectively, these conserved junctional adjustments suggest strongselection for HCDR3 structure. Three rearranged L chain sequences wereavailable for this set and both contained the VKA27 gene associated withJκ1, Jκ4, or Jκ5. The germline sequences along the top are SEQ ID NO:34and 35 (V_(H)1-69), SEQ ID NO:75 and 76 (D3-16), SEQ ID NO:77 and 78(J_(H)3), SEQ ID NO:240 and 241 (V_(K)A27) and SEQ ID NO:242 and 243(J_(K)1/4/5). The sequences of the individuals on the left side of FIG.4, from top to bottom, are SEQ ID NO:79-82, 244, 245 and 83-88,respectively. The sequences of the individuals on the right side of FIG.4, from top to bottom, are SEQ ID NO:246-251, respectively.

FIG. 5 shows amino acid and nucleotide sequences of the CDR3 and itsjunctions of Set VIII. The VH-D junctions are dominated by non-templatedGs. The D-JH junction exhibits evidence of trimming and fill-in, with analteration to M where the final D encoded residue would be found. Thisis not a known site of polymorphism, although that explanation cannot beexcluded. Only one L chain sequence was available for this set (GO13),and this consisted of the VκL6 and Jκ3 genes. There was significantoverlap between the germline segments at the VL-JL junction. Thegermline sequences along the top are SEQ ID NO:34 and 35 (V_(H)1-69),SEQ ID NO:252 and 253 (D2-2), SEQ ID NO:23 (J_(H)6 DNA); SEQ ID NO:254and 255 (V_(K)L6) and SEQ ID NO:256 and 257 (J_(K)3). The sequences ofthe individuals on the left side of FIG. 5, from top to bottom, are SEQID NO:258-262, respectively. The sequences of the individuals on theright side of FIG. 5, from top to bottom, are SEQ ID NO:263 and 264,respectively.

FIG. 6 shows amino acid and nucleotide sequences of the CDR3 and itsjunctions of Set V. In these sequences, the 5′ end of the germline Dgene overlaps the 3′ end of the germline IgVH segment to form the VH-Djunction. The presence of several nucleotides that do not match eithergermline sequence in the overlap region suggests that trimming andaddition occurred, resulting in a preferred insertion of a residue witha small (A, S, and V) or no (G) side chain. The amino acids at the D-JHjunction are not well conserved. However, the consistent relativepositioning of the VII, D, and JH segments is intriguing because theregion of overlap between the VH and D does not contain significanthomology as might be predicted for preferential recombination. Thissuggests selection for HCDR3 configuration and D-encoded residues ratherthan specific junctional residues. Two rearranged L chain sequences wereavailable from this set (RF22 and GN12) and both were comprised ofVλ1.16 (1c) and Jλ1 segments. The level of mutation of both the H and Lchains in the members of sets IV, V, and VIII was always <2%, which isconsistent with published reports of the frequent lack or scarcity ofmutations in the VH1-69 in B-CLL (Kipps et al., 1989; Schroeder et al.,1994; Fais et al., 1998). The germline sequences along the top are SEQID NO:34 and 35 (V_(H)1-69), SEQ ID NO:89 and 90 (D3-10), SEQ ID NO:23(J_(H)6 DNA), SEQ ID NO:265 and 266 (V_(λ)1-16) and SEQ ID NO:267 and268 (V_(λ)1/3). The sequences of the individuals on the left side ofFIG. 6, from top to bottom, are SEQ ID NO:269-274 and 93-99,respectively. The sequences of the individuals on the right side of FIG.6, from top to bottom, are SEQ ID NO:275-278, respectively.

FIG. 7 shows amino acid and nucleotide sequences of the CDR3 and itsjunctions of Set II. The H chain junctions of the sequences in this setof five cases are quite constrained. The position of the D (D5-5)relative to both VH (VH 4-34) and JH (JH6) segments is identical foreach member, leading to equal HCDR3 lengths. The VH-D and D-JH junctionsboth contain evidence of trimming and addition. These processes producedan aromatic residue (W, Y, F) at the VH-D junction (position 5) followedby a hydrophobic residue (G, P, or A at position 6) and a pair of codonsencoding basic residues (K or R) at the D-JH junction (positions 12 and13). At position 9 in the D segment, four out of the five HCDR3sequences exhibit a P rather than an A found in the canonical D5-5segment deposited in the public databases. Although this is most likelya polymorphism of the D5-5 segment rather than a common mutation, thelast of the five sequences in this set (CLL ID47) also deviates from thecanonical D5-5 sequence at this codon, substituting a D. These highlyconserved alterations of the VH-D-JH junctions suggest selection for avery particular HCDR3 structure. The rearranged L chains of this set arealso very similar. All three available VLJL sequences use VκA17 andeither Jκ1 or Jκ2. The junctions are highly similar with only a singledifference that results from an abbreviated recombination thateliminates the junctional P from CLL240. These cases are of the IgGisotype. Like most IgG⁺ B-CLL cases that express a switched isotype(Fais et al. 1998; Hashimoto et al., 1992; Ghiotto et al., 2004), thesecases exceed the 2% difference from germline, albeit slightly, and arethus classified as mutated. The germline sequences along the top are SEQID NO:19 and 20 (V_(H)4-34), SEQ ID NO:21 and 22 (D5-5), SEQ ID NO:23(J_(H)6 DNA), SEQ ID NO:279 and 280 (V_(K)A17) and SEQ ID NO:281 and 282(J_(K)1/2). The sequences of the individuals on the left side of FIG. 7,from top to bottom, are SEQ ID NO:24 to 33, respectively. The sequencesof the individuals on the right side of FIG. 7, from top to bottom, areSEQ ID NO:283-286, 283 and 287, respectively.

FIG. 8 shows amino acid and nucleotide sequences of the CDR3 and itsjunctions of set VI. The VH1-02 germline sequence is shown. There are nosequence differences between VH1-02 and VH1-03, 1-18, 1-46, or 5-51 forthe displayed region. The Jκ1 gene is shown, and homology between CLL011and CLL-412 and Jκ2 at positions where the germline sequence of J κ2 andJ κ1 are different is indicated with an asterisk. This set is composedof five subsets, totally 22 patients that share HCDR3 and VLDLcharacteristics but incorporate different IgVH genes (1-02, 1-03, 1-18,1-46, and 5-51). Each of these genes belongs to the same VH clan(Kirkham et al., 1992). The HCDR3 of these subsets all share a preciseVHD overlap. Curiously, the D6-19 segment was used in a nonproductivereading frame. However, this stop codon was in the region of overlapwith the terminal IgVH sequence and was trimmed, thereby allowingproductive rearrangements with the JH4 segment. The D-JH junctionscontain evidence for trimming and addition. The first nongermlinetemplated codon after the D segment is enriched in redundant L codons,but the remaining junctional codons are not tightly conserved. All therearranged L chains available for this set use the VκO12/2 gene with Jκ,use restricted to Jκ1 and Jκ2. Of these 10 sequences, 9 are essentiallyidentical to that of the germline in the LCDR3 and junctional regions.Thus, this set is unified not only by its common HCDR3 structure andmotifs but also by the use of a virtually identical VLJL partner with avery restricted LCDR3 composition. The germline sequences along the topare SEQ ID NO:34 and 35 (J_(H)1-02), SEQ ID NO:36 and 37 (D6-19), SEQ IDNO:38 and 39 (J_(H)4), SEQ ID NO:288 and 289 (V_(K)O12/02) and SEQ IDNO:281 and 282 (J_(K)1/2). The sequences of the individuals on the leftside of FIG. 8, from top to bottom, are SEQ ID NO:40, 41, 44, 45, 42,43, 46-53, 57-64, 71-74, 69, 70, 67, 68, and 116-128, respectively. Thesequences of the individuals on the right side of FIG. 6, from top tobottom, are SEQ ID NO:290-295, 294, 296-298, 294, 295, 294, 291, 294,295, 288, 290, 299 and 300, respectively.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is based on the discovery that a significantproportion of B-CLL patients having genetic and protein markersconsistent with an aggressive form of the disease or a manifestlyaggressive form of the disease regardless of said markers, have B-CLLcells with B cell receptors encoded by antibody gene family members thatother B-CLL patients also have. The inventors have identified at least10 sets of patients (see Table 1 in the Example), % where the patientswithin each set have the same B-CLL B cell receptor antibody genes. Thisaccounts for approximately 10% of B-CLL patients, and about 20% of thosepatients that have genetic and protein markers consistent with anaggressive form of the disease. See the Example for details relating tothe discovery of these sets.

As is known, aggressive forms of B-CLL are correlated with B cells thathave relatively few IgV gene mutations and have intercellular expressionof ZAP-70, and cell surface expression of CD38 and CD23. These markersare evaluated at first diagnosis to predict which patients will have anaggressive form of the disease, in order to determine a course oftreatment. Because the B-CLL cells from patients belonging to identified“sets” with common B cell receptor genes have low or absent IgVmutations (see Table 1 in Example), it is predicted that patients havingB-CLL cells from each of these sets will have an aggressive form of thedisease.

The Figures provide relevant sequences of the B cell receptor antibodiesand antibody genes of B-CLL cells of several patients in the sets.Notable is the relatively small amount of variation within each set inthe number of nucleotides added during the VH-D-JH and VL-JLrecombinations.

While two of these sets (Sets I and III have been previously identified,it was believed that those two sets were anomalous and were not expectedto account for more than a small fraction of B-CLL cases. Thus, thediscovery, disclosed herein, of multiple other sets that account for asignificant proportion of patients with B-CLL, in particular theapparently aggressive form of the disease, makes practical the use ofvarious methods and compositions for diagnosis and treatment of B-CLL,based on the sets identified.

Thus, in some embodiments, the present invention is directed to isolatedand purified preparations of a combination of a light chain antibodygene and a heavy chain antibody gene. The family members of the lightchain antibody gene and the heavy chain antibody gene of thesepreparations make up any one of the following sets:VH4-39/D6-13/JH5/VLκO12/2/JLκ1/κ2 (Set I),VH4-34/D5-5/JH6/VLκA17/JLκ1/κ2 (Set II), VH3-21/JH6/VLλ3h/JLλ3 (SetIII), VH1-69/D3-16/JH3/VLκA27/JLκ1/κ4 (Set IV),VH1-69/D3-10/JH6/VLλ1c/JLλ1 (Set V), VH1-2/D6-19/JH4/VLκO12/2/JLκ1/κ2(Set VIa); VH1-03/D6-19/JH4/VLκO12/2/JLκ1/κ2 (Set VIb);VH1-18/D6-19/JH4/VLκO12/2/JLκ1 (Set VIc); VH1-46/D6-19/JH4 (Set VId);VH5-51/D6-19/JH4/VLκO12/2/JLκ2 (Set VIe), VH1-69/D3-3/JH4/VLκA19/JLκ4(Set VII), and V_(H)1-69/D2-2/J_(H)6/V_(L)κL6/2/J_(L)κ3 (Set VII). Insome preferred embodiments, the family members of the light chainantibody gene and the heavy chain antibody gene are selected from thegroup consisting of Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, Set VII, and Set VIII; in other preferred embodiments,the family members of the light chain antibody gene and the heavy chainantibody gene are selected from the group consisting of Set II, Set IV,Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VII. Inadditional preferred embodiments, the family members of the light chainantibody gene and the heavy chain antibody gene are selected from thegroup consisting of Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, and Set VIII. In still other preferred embodiments,the family members of the light chain antibody gene and the heavy chainantibody gene are selected from the group consisting of Set I, Set II,Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, andSet VII.

These preparations, comprising the antibody genes of each of the 12identified sets, are useful for preparing reagents for diagnosis andtreatment methods described below. Such useful reagents includecompounds that specifically bind to the antigen binding site of theantibodies encoded by these genes, as further described below.

The antibody genes in these sets can be identified without undueexperimentation by known methods, e.g., as described in the Example,using routine sequencing methods. The antibody genes are categorizedherein as from a particular germline gene even if the antibody gene hasseveral mutations.

The combination of antibody genes can be in any form, including singlechain genes, as are known in the art. Preferably, the antibody genes areon a vector or vectors, such as a plasmid or viral vector, in order tofacilitate their maintenance, as with a cloning vector, and to be ableto produce the antibodies encoded by the genes, as with an expressionvector. Cells in culture comprising a vector comprising antibody genesfrom Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, Set VII, or Set VIII are also envisioned. Preferably,the antibody genes are selected from the group consisting of Set II, SetIV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, and SetVII, or Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, SetVIe, and Set VII, or Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, and Set VII, or Set I, Set II, Set III, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VII.

In other embodiments, the invention is directed to isolated and purifiedantibodies encoded by antibody genes from one of Set I, Set II, Set III,Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, orSet VIII. Preferably, the antibody genes are selected from the groupconsisting of Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId,Set VIe, Set VII, and Set VII, or Set II, Set IV, Set V, Set VIa, SetVIb, Set VIc, Set VId, Set VIe, and Set VII, or Set II, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VIII, or Set L SetII, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe,and Set VII. As previously discussed, these antibodies, which areexpressed as the B cell receptor on the B-CLL cells from individuals inthe identified sets, can be used to identify reagents that bind to theantibody's antigen binding site. These antibodies can be produced by anyknown method. Non-limiting examples include antibodies from a hybridomamade from the CLL cells and antibodies from cloned antibody genes. Asused herein, the antibodies can be in any form that includes at leastone antigen binding region. The term “antibody” thus includes an Fab,Fab2, or Fv fragment. The present invention also includes hybridomasthat produce the above antibodies.

As is known in the art, a consensus sequence for each set can beidentified that provides the amino acid sequence that is most similar tothe sequence of the antibodies of all members of the set. This consensussequence can be used to identify an antibody binding site that is mostsimilar to all the members of the set, in order to most efficientlyproduce a binding partner (e.g., an anti-idiotype antibody) that bindsto all members of the set. Thus, the invention is also directed to theseamino acid consensus sequences and to nucleotide sequences encoding theconsensus sequences.

The invention is also directed to anti-idiotype antibodies that bind tothe antigen-binding region of an antibody encoded the antibody genes ofSet I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, SetVId, Set VIe, Set VII, or Set VIII. Preferably, the antibody genes areselected from the group consisting of Set It, Set IV, Set V, Set VIa,Set VIb, Set VIc, Set VId, Set Vie, Set VII, and Set VIII, or Set II,Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VII,or Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe,and Set VIII, or Set L Set II, Set III, Set IV, Set V, Set VIa, Set VIb,Set VIc, Set VId, Set VIe, and Set VII. Since these anti-idiotypeantibodies bind to the antibody binding site of the antibodies that arethe B cell receptor of a B-CLL cells from a significant portion of B-CLLpatients with the aggressive form of the disease, the anti-idiotypeantibodies can be used in various diagnostic and treatment methods forB-CLL.

The anti-idiotype antibodies of these embodiments can be made bystandard methods, e.g., screening a phage display library, or producinga hybridoma making monoclonal antibodies against the antigen bindingsite of the antibodies encoded by the various B-CLL gene sets describedabove. As such, these anti-idiotype antibodies can be from anyvertebrate species but are preferably mouse antibodies, humanantibodies, or humanized antibodies. Such antibodies can be made byknown methods without undue experimentation. The present invention alsoincludes hybridomas that produce the above anti-idiotype antibodies.

In related embodiments, the invention is directed to bispecificantibodies comprising the binding site of any of the above-describedanti-idiotype antibodies and a binding site that binds to another B cellantigen. The B cell antigen can be any antigen on the B cell, such as asignal-transducing antigen (either surface or intracellular), or asurface antigen. It is expected that, in many cases, the bi-specificantibodies having a binding site to a B cell surface antigen would bindto the B cell more tightly than an antibody with two anti-idiotypebinding domains, since anti-idiotype antibodies can be of low avidity.The bi-specific antibodies having a binding site to a signal-transducingantigen would be expected to expedite the signaling pathway, such as aterminal differentiation pathway or an apoptotic pathway, thusexpediting the elimination of a B cell contributing to the B-CLLdisease.

The above anti-idiotype antibodies can also be combined in a mixturethat provides the antibodies directed to the binding sites from morethan one set. This mixture can include as many anti-idiotype antibodiesas desired, including those any combination, or all of the sets. Thelatter mixture would be effective in diagnosis or treatment methods forall of the sets, rather than just one set.

When used for treatment methods, the above-described anti-idiotypeantibodies or mixtures thereof would be in a pharmaceutically acceptableexcipient.

The above-described anti-idiotype antibody compositions can beformulated without undue experimentation for administration to a mammal,including humans, as appropriate for the particular application.Additionally, proper dosages of the compositions can be determinedwithout undue experimentation using standard dose-response protocols.

Accordingly, the compositions designed for oral, lingual, sublingual,buccal and intrabuccal administration can be made without undueexperimentation by means well known in the art, for example with aninert diluent or with an edible carrier. The compositions may beenclosed in gelatin capsules or compressed into tablets. For the purposeof oral therapeutic administration, the pharmaceutical compositions ofthe present invention may be incorporated with excipients and used inthe form of tablets, troches, capsules, elixirs, suspensions, syrups,wafers, chewing gums and the like.

Tablets, pills, capsules, troches and the like may also contain binders,recipients, disintegrating agent, lubricants, sweetening agents, andflavoring agents. Some examples of binders include microcrystallinecellulose, gum tragacanth or gelatin. Examples of excipients includestarch or lactose. Some examples of disintegrating agents includealginic acid, corn starch and the like. Examples of lubricants includemagnesium stearate or potassium stearate. An example of a glidant iscolloidal silicon dioxide. Some examples of sweetening agents includesucrose, saccharin and the like. Examples of flavoring agents includepeppermint, methyl salicylate, orange flavoring and the like. Materialsused in preparing these various compositions should be pharmaceuticallypure and nontoxic in the amounts used.

In preferred embodiments, the anti-idiotype antibody compositions of thepresent invention can easily be administered parenterally such as forexample, by intramuscular, intrathecal, subcutaneous, intraperitoneal,or, in the most preferred embodiments, intravenous injection. Parenteraladministration can be accomplished by incorporating the compositions ofthe present invention into a solution or suspension. Such solutions orsuspensions may also include sterile diluents such as water forinjection, saline solution, fixed oils, polyethylene glycols, glycerine,propylene glycol or other synthetic solvents. Parenteral formulationsmay also include antibacterial agents such as for example, benzylalcohol or methyl parabens, antioxidants such as for example, ascorbicacid or sodium bisulfite and chelating agents such as EDTA. Buffers suchas acetates, citrates or phosphates and agents for the adjustment oftonicity such as sodium chloride or dextrose may also be added. Theparenteral preparation can be enclosed in ampules, disposable syringesor multiple dose vials made of glass or plastic.

Rectal administration includes administering the pharmaceuticalcompositions into the rectum or large intestine. This can beaccomplished using suppositories or enemas. Suppository formulations caneasily be made by methods known in the art. For example, suppositoryformulations can be prepared by heating glycerin to about 120° C.,dissolving the composition in the glycerin, mixing the heated glycerinafter which purified water may be added, and pouring the hot mixtureinto a suppository mold.

Transdermal administration includes percutaneous absorption of theanti-idiotype antibody composition through the skin. Transdermalformulations include patches (such as the well-known nicotine patch),ointments, creams, gels, salves and the like.

The present invention includes nasally administering to the mammal atherapeutically effective amount of the composition. As used herein,nasally administering or nasal administration includes administering thecomposition to the mucous membranes of the nasal passage or nasal cavityof the patient. As used herein, pharmaceutical compositions for nasaladministration of a composition include therapeutically effectiveamounts of the composition prepared by well-known methods to beadministered, for example, as a nasal spray, nasal drop, suspension,gel, ointment, cream or powder. Administration of the anti-idiotypeantibody composition may also take place using a nasal tampon or nasalsponge.

In other embodiments, the invention is directed to peptide antigens thatbind to the antigen-binding region of an antibody encoded by antibodygenes from Set L Set II, Set III, Set IV, Set V, Set VIa, Set VIb, SetVIc, Set VId, Set VIe, Set VII, or Set VIII. Preferably, the antibodygenes are selected from the group consisting of Set II, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, and Set VIII, orSet II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, andSet VII, or Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId,Set VIe, and Set VIII, or Set I, Set II, Set III, Set IV, Set V, SetVIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VI. Such peptideantigens can be made by well-known methods, e.g., phage display libraryor high-density peptide library, without undue experimentation.

As used herein, the term “peptide antigen” includes peptide mimetics,also known as peptidomimetics, which retain the same binding abilitiesas the analogous amino acid peptide. Peptide mimetics are peptidescomprised of amino acid analogs, such as D-amino acids, that are moreresistant to protease degradation than their L-amino acid peptidecounterparts. Various peptide mimetics are known in the art, and anypeptide mimetic can be produced without undue experimentation.

As is analogous with the anti-idiotype antibodies, these peptideantigens can be prepared as a mixture, in order to provide a diagnosticor therapeutic reagent useful for several, or all of the B-CLL sets.Also as with the anti-idiotype antibodies, the peptide antigens can alsobe usefully provided in a pharmaceutically acceptable excipient, fortherapeutic applications, preferably for parenteral administration.

In further embodiments, the invention is directed to aptamers that bindto the antigen-binding region of an antibody encoded by antibody genesfrom Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, Set VII, or Set VIII. Preferably, the antibody genesare selected from the group consisting of Set II, Set IV, Set V, SetVIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, and Set VIII, or SetII, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and SetVII, or Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, SetVIe, and Set VIII, or Set I, Set II, Set III, Set IV, Set V, Set VIa,Set VIb, Set VIc, Set VId, Set VIe, and Set VII. As is known, aptamersare single stranded oligonucleotides or oligonucleotide analogs thatbind to a particular target molecule, in this case an antibody bindingsite. Thus, aptamers are the oligonucleotide analogy to antibodies.However, aptamers are smaller than antibodies, generally in the range of50-100 nt. Their binding is highly dependent on the secondary structureformed by the aptamer oligonucleotide. Both RNA and single stranded DNA(or analog), aptamers are known. Thus, these aptamers are analogous tothe anti-idiotype antibodies and the peptide antigens previouslydiscussed. As such, they can also be provided as a mixture of two ormore, in order to have a reagent that can be utilized with more than oneset of patients. They can also be provided in a pharmaceuticallyacceptable excipient, for therapeutic purposes, preferably forparenteral administration.

In some embodiments, the anti-idiotype antibody, peptide antigen,aptamer, or mixtures of these as previously described can usefully befunctionalized or derivatized. One useful derivitization includes acellular toxin. Such reagents are useful in a “magic bullet” approach toB-CLL therapy, where the toxin would be expected to kill only the B-CLLcell that the anti-idiotype antibody, peptide antigen, or aptamer bound.Several cellular toxins known in the art for these embodiments can beused for this approach, including radioactive moieties, ricin, andchemotherapeutic agents.

In other embodiments, the anti-idiotype antibody, peptide antigen,aptamer, or mixtures of these as previously described can usefully befurther functionalized to comprise a detectable moiety, such as afluorophore, or an enzyme that can be treated with a substrate toproduce a colored reaction product. Non-limiting examples of the latterenzyme is horseradish peroxidase and alkaline phosphatase. Such labeledanti-idiotype antibody, peptide antigen, aptamer, or mixtures can beused for diagnostic purposes, for example in labeling the B-CLL cellsfor fluorescence activated cell sorter analysis or for histologicalobservation of the cells. These methods are more fully described below.

In additional embodiments, the invention is directed to multimericmolecules comprising at least a first and a second binding site, thefirst binding site binding to the antigen-binding region of an antibodyencoded by antibody genes from Set I, Set II, Set III, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, Set VII, or Set VIII, andthe second binding site binding to either (a) the same antigen-bindingregion of an antibody as the first binding site or (b) another B-cellantigen. Preferably, the antibody genes are selected from the groupconsisting of Set II, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId,Set VIe, Set VII, and Set VIII, or Set II, Set IV, Set V, Set VIa, SetVIb, Set VIc, Set VId, Set VIe, and Set VII, or Set II, Set IV, Set V,Set VIa, Set VIb, Set VIc, Set VId, Set VIe, and Set VIII, or Set I, SetII, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe,and Set VII. By providing multiple binding sites to a particular set,these multimeric compositions would be expected to bind more effectivelythan the single binding site peptide antigens or aptamers, or the doublebinding site anti-idiotype antibodies, as described above. In preferredembodiments, the multimeric molecules of these embodiments comprise morethan five binding sites. These multimeric molecules can be made by theskilled artisan without undue experimentation.

In some embodiments, all of the binding sites of the multimeric moleculebind to the antigen-binding region of an antibody encoded by antibodygenes from Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, SetVIc, Set VId, Set VIe, Set VII, or Set VIII. These binding sites can bedirected to one epitope, to more than one epitope of the antigen-bindingregion, or to antigen-binding regions of more than one set.

In these multimeric molecules, the binding sites can be all antibodybinding sites, all peptide binding sites, all aptamer binding sites, orcombinations thereof.

More generally, the invention is further directed to an isolated andpurified preparation of a combination of a light chain antibody gene anda heavy chain antibody gene, where the gene family members of the lightchain antibody gene and the heavy chain antibody gene are present in Bcells of two or more patients, where the antibody chains of the B cellsalso share the same isotype, JH, D and JL regions, and where the B cellsare lymphoproliferative in the patient, or where the patient has anautoimmune disease involving the B cells.

The discovery that B-CLL patients can be classified into sets havingcommon antibody chains raises the possibility that otherlymphoproliferative or autoimmune diseases involving B cells can also beclassified into sets, where each set of patients share B cells that areinvolved in the disease with the same antibody genes. The instantdisclosure provides evidence for this, since a patient in Set I has animmunocytoma, a patient in set I has a small cell lymphocytic lymphoma(SLL), and a patient in set VIa has a marginal zone lymphoma (SMZL)(FIG. 1). It is also highly probable that other B-CLL sets exist.

Preferred lymphoproliferative disorders within these embodiments includeHodgkin's disease, non-Hodgkin's lymphoma, Burkitt's lymphoma, myeloma,a monoclonal gammopathy with antibody-mediated neurologic impairment, amonoclonal gammopathy of unknown significance, and a monoclonallymphocytosis of undetermined significance. Preferred autoimmunediseases within these embodiments include systemic lupus erythematosus,myasthenia gravis, Grave's disease, type I diabetes mellitus, autoimmuneperipheral neuropathy, and autoimmune hemolytic anemia.

As previously discussed, the above compositions are useful for variousdiagnostic and therapeutic methods that are envisioned as part of theinvention.

Thus, in some embodiments, the invention is directed to methods of

(a) determining whether a patient with B cell chronic lymphocyticleukemia (B-CLL) has a form of B-CLL susceptible to treatment directedto eliminating idiotype-specific B cell receptor-bearing B-CLL cells, or

(b) following the progression of treatment of B-CLL in a patient havinga form of B-CLL susceptible to treatment directed to eliminatingidiotype-specific B cell receptor-bearing B-CLL cells. In theseembodiments, the methods comprise determining whether the B cellreceptors on the B-CLL cells have an idiotype encoded by antibody genesfrom Set I, Set II, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc,Set VId, Set VIe, Set VII, or Set VIII. A determination that the B cellreceptors have the specified idiotype at once establishes that thepatient apparently has an aggressive form of B-CLL, and that the B-CLLcan be treated using the anti-idiotype, peptide, aptamer, mixtures, ormultimeric molecules described above, particularly those conjugated to acellular toxin. Additionally, by continual monitoring of the idiotype ofthe B cells from the patient, one can follow the progress of treatment,since an effective treatment would exhibit a decreasing amount of Bcells having an idiotype from the B-CLL set. No B cells having anidiotype from the B-CLL set essentially means that the patient is inremission or cured of the B-CLL.

It can be seen, then, that it is useful to monitor progression of thetreatment by quantifying the B cells having an idiotype from the B-CLLset, since a decreasing quantity of the B cells indicates an effectivetreatment, while an increasing quantity of the B cells indicates anineffective treatment.

In these methods the determination step can be by any means known in theart. Nonlimiting examples include (a) amplification ofidiotype-determining regions of the antibody genes or mRNA, e.g., bypolymerase chain reaction, and evaluating whether the amplified regionsare amplified from the B-CLL set in question; (b) sequencing theamplified regions; (c) evaluating whether the amplified regionshybridize with equivalent regions from the B-CLL set in question; (d)evaluating whether the patient has circulating antibodies with anidiotype encoded by the antibody genes from the B-CLL set in question;(e) evaluating whether the patient has antibodies that bind to a bindingagent (e.g., an anti-idiotype antibody, a peptide antigen, or anaptamer, as described above, preferably comprising a detectable moiety)specific for the idiotype encoded by the antibody genes from the set inquestion; or (f) mixing a labeled anti-idiotype antibody, peptideantigen, or aptamer with lymphocytes of the patient and determiningwhether lymphocytes that bind to the composition are present, e.g.,using a Coulter counter or a cell sorter.

The above methods can be used with a B-CLL patient at any stage of thedisease, including in a pre-leukemic, early leukemic, frank leukemicstate. Furthermore, the B-CLL cells can be obtained from the blood, thebone marrow, the spleen, and/or the lymph nodes, depending on theresults of initial diagnosis and the stage of the disease.

The present invention is also directed to methods of treating a patienthaving B-CLL caused by B cells comprising antibody genes from Set I, SetA, Set III, Set IV, Set V, Set VIa, Set VIb, Set VIc, Set VId, Set VIe,Set VII, or Set VIII. The methods comprise administering to the patientthe above described anti-idiotype antibody, peptide antigen, aptamer, ormixture as previously described, in a pharmaceutically acceptableexcipient.

Although the anti-idiotype antibody, peptide antigen, aptamer, ormixture by themselves could be effective in eliminating the B cells,because they could set off an apoptotic cascade in the cells, it ispreferred that the anti-idiotype antibody, peptide antigen, aptamer, ormixture also comprise a cellular toxin, as described above, that candirectly kill the cell.

Additionally, the invention is directed to methods of identifying otherB-CLL sets. The methods comprise identifying the VH, D, JH, VL, and JLclasses of antibody genes present on B-CLL cells, where the same classesare all present in more than one B-CLL patient. It is understood thatdatabases and computerized comparison methods could be employed in thisidentification process.

Once additional sets are identified, a compound that binds to theantigenic site of an antibody encoded by the antibody genes can beidentified by methods previously described, where the compound is usefulfor therapeutic and diagnostic purposes. Since the results provided inthe Example establish that a significant proportion of B-CLL patientsare in a set that shares the same B-CLL antibody genes with otherpatients, it is highly likely that other sets will be found.

It would be understood by the skilled artisan that the therapeutic agentin these methods is preferably an anti-idiotype antibody, a peptideantigen, or an aptamer that binds to the antigen binding site of theantibody encoded by the antibody genes that are typical of a ‘set’.

Preferred embodiments of the invention are described in the followingexamples. Other embodiments within the scope of the claims herein willbe apparent to one skilled in the art from consideration of thespecification or practice of the invention as disclosed herein. It isintended that the specification, together with the examples, beconsidered exemplary only, with the scope and spirit of the inventionbeing indicated by the claims, which follow the examples.

Example 1 Multiple Distinct Sets of Stereotyped Antigen ReceptorsIndicate a Role for Antigen in Promoting Chronic Lymphocytic Leukemia

Example Summary.

Previous studies suggest that the diversity of the expressed variable(V) region repertoire of the Ig H chain of B-CLL cells is restricted.Although limited examples of marked constraint in the primary structureof the H and L chain V regions exist, the possibility that this level ofrestriction is a general principle in this disease has not previouslybeen known. This report describes eight sets of patients, mostly withunmutated or minimally mutated IgV genes, with strikingly similar BCRarising from the use of common H and L V region gene segments that shareCDR3 structural features such as length, amino acid composition, andunique amino acid residues at recombination junctions. Thus, a much morestriking degree of structural restriction of the entire BCR and a muchhigher frequency of receptor sharing exists among patients thanpreviously appreciated. The data imply that either a significantfraction of B-CLL cells were selected by a limited set of antigenicepitopes at some point in their development and/or that they derive froma distinct B cell subpopulation with a limited Ig V region diversity.These shared, stereotyped Ig molecules may be valuable probes forantigen identification and important targets for cross-reactiveidiotypic therapy. Sets II, IV, V, VI and VIII are described in Messmeret al., 2004, where they are named Sets IV, III, V and II, respectively.Introduction.

The B-lymphocyte clone expanded in chronic lymphocytic leukemia (B-CLL)expresses low levels of surface membrane Ig, the B cell antigen receptor(BCR). The genetics of this Ig have clinical relevance, as patients witha clone whose Ig variable (V) region has no or few mutations have asignificantly worse outcome than those with significant numbers of Ig Vmutations (Damle et al., 1999; Hamblin et al., 1999). The biologyunderlying this association is unclear.

Several lines of evidence support a role for the BCR in the evolution ofB-CLL (reviewed in Chiorazzi and Ferrarini, 2003). The distribution ofindividual IgV_(H) in B-CLL clones differs from that found in normalcells (Fais et al., 1998), with an increased frequency of V_(H)1-69,V_(H)4-34, and V_(H)3-07 (Fais et al., 1998; Schroeder and Dighiero,1994; Johnson et al., 1997). In addition, the distribution of mutationsamong B-CLL cases using these specific V_(H) genes is selectively biased(Fais et al., 1998; Schroeder and Dighiero, 1994; Kipps et al., 1989).

Recently two subgroups of B-CLL cases with remarkable similarity of theentire BCR (V regions of the H and L chain) were identified (Tobin etal., 2003; Ghiotto et al., 2004). Although these findings areprovocative, they have been considered rare and potentially anomalous,since, in one instance the clones expressed IgG (Ghiotto et al., 2004)and in the other geography and ethnicity may be relevant (Tobin et al.,2002). This report describes another eight groups of B-CLL patients thatexpress BCRs of strikingly similar primary structure defined by highlysimilar Ig V regions in the H and L chains and, in particular, distinctH and L CDR3 configurations. Thus, a significant fraction of B-CLLclones derive from B-lymphocytes with constrained antigen binding sitesthat could recognize individual, discrete antigen(s) or classes ofstructurally similar epitopes.

Materials and Methods

IgV gene sequencing. V_(H)DJ_(H) and V_(L)J_(L) sequences weredetermined by previously described methods (Fais et al., 1998; Ghiottoet al., 2004).

Database Searches. B-CLL Ig H chain V amino acid sequences from ourcollection (n=255) and the public databases (n=197) were subjected toBLAST searches of both nucleotide and protein databases to identifysimilar sequences. The criteria used to define “Sets” of similarrearranged V_(H)DJ_(H) were: A) use of the same V_(H), D, and J_(H)germline genes, B) use of the same D segment reading frame and positionrelative to the V_(H), plus or minus one codon, and C) an amino acidsimilarity within the HCDR3 of >60% identity. In addition, all B-CLL IgH protein sequences were aligned and clustered using the ClustalWalignment algorithm. Sequences clustering tightly were visuallyinspected for similarity. All of these searches used the completeV_(H)DJ_(H) and as such were weighted toward sequences that used thesame V_(H) gene. To identify sequences with similar HCDR3 but differentV_(H) genes, CDR3 motifs from the various sets were used to search thepublic databases with the ProteinInfo search engine(http://prowl.rockefeller.edu/). The criteria for the members of Set Vwere altered to permit the use of different IgV_(H) genes that weremembers of the same IgV_(H) clan, while retaining the criteria for therearranged V_(L)J_(L). Use of the same specific IgV_(L) gene and >85%LCDR3 identity was required for the inclusion of a companion rearrangedV_(L)J_(L) in a Set.

538 V_(H) sequences from CD5⁺ and CD5⁻ peripheral B-lymphocytes (Tobinet al., 2002; Geiger et al., 2000) were downloaded from the publicdatabase. These 538 sequences were independently compared to thetranslated databases using tblastn on the BlastMachine at the AMDeCBioinformatics Core Facility at the Columbia Genome Center, ColumbiaUniversity.

Detailed nucleotide and amino acid sequence alignments of the junctionalregions and complete protein sequence alignments of the sequencesdescribed here are provided in the Figures.

Results and Discussion

Identification of subgroups of B-CLL patients with highly restrictedV_(H)DJ_(H) and shared HCDR3 configurations. Each B-CLL-derivedV_(H)DJ_(H) sequence in our database was compared with every B-CLLsequence in our collection (n=255) as well as with those in the publicIg V gene databases (n=197) using nucleotide and protein sequence BLAST.In addition, all available B-CLL H chain V region sequences werephylogenetically grouped using the ClustalW method; sequences thatclustered together were further analyzed for HCDR3 sequence similarity.These screening methods identified Sets of sequences (Table 1)consisting of the same IgV_(H) with highly similar HCDR3 resulting fromidentical D (when identifiable) and JH segment use, D segment readingframe, similar D segment position relative to IgV_(H), and HCDR3 length,and significant (>60%) amino acid sequence identity.

TABLE I Sets of B-CLL cases that share Ig V region genes and have a highdegree of similarity in H CDR3. Int. Public Pub. V_(H) Mutation % SetB-CLL^(a) B-CLL other Isotype V_(H) max min median D J_(H) V_(L) J_(L) I5 0 1^(b) IgG 4-39 1.0 0.0 0.5 6-13 5 κO12/2 (4/5) κ1/κ2 II 3 2 0 IgG4-34 3.1 2.0 2.7 5-5 6 κA17 (3/3) κ1/κ2 III 3 2 2^(c) IgM 3-21 2.4 0.01.4 ND 6 λ3h (4/4) λ3 IV 2 2 1^(d) IgM 1-69 0.6 0.0 0.0 3-16 3 κA27(2/2) κ1/κ4 V 0 4 0 IgM 1-69 0.3 0.0 0.3 3-10 6 λ1-16 (1/1) λ1 VIa 4 21^(e) IgM 1-02 0.3 0.0 0.0 6-19 4 κ O12/2 (4/4) κ1/κ2 VIb 2 4 0 IgM 1-032.0 0.3 0.8 6-19 4 κ O12/2 (3/3) κ1/κ2 VIc 1 0 0 IgM 1-18 1.2 1.2 1.26-19 4 κ O12/2 (1/1) κ1 VId 0 2 0 IgM 1-46 0.0 0.0 0.0 6-19 4 0/0 VIe 16 0 IgM 5-51 2.7 0.0 0.2 6-19 4 κ O12/2 (1/2) κ2 VII 2 0 0 IgM 1-69 0.00.0 0.0 3-3 4 κ A19 (1/1) κ4 VIII 3 0 0 IgM 1-69 0.0 2-2 6 κL6 κ3^(a)Internal B-CLL ^(b)immunocytoma, accession Y09249 ^(c)smalllymphocytic leukemia, accession AF299104, and elderly normal, accessionAF174100 ^(d)anti-cardiolipin antibody, accession AF460965 ^(e)smallmarginal zone lymphoma, accession AJ487492

Three subsets of Set VI (VIa, VIb, and VIe) contained sequences thatutilized different IgV_(H) genes but used the same D and JH segments,the same Vκ, and had highly similar HCDR3 configurations. Therefore, weused the HCDR3 motif common to these three subsets to search publicdatabases for additional sequences with the same HCDR3 configurationpotentially associated with a different IgV_(H) segment. This search wasnot restricted to B-CLL sequences. The approach confirmed the previouslyidentified subsets and identified two additional subsets of Set VI (VIcand VId).

The public database searches identified 21 V_(H)DJ_(H) sequences,belonging to one of the eight individual Sets, bringing the total numberof sequences among these Sets to 45. Interestingly, only two of the 21sequences culled from the public databases were not derived from B-CLLcells. These two were from an anti-cardiolipin antibody producing B cell(Set IV) and from a splenic marginal zone lymphoma (Set VIa). Thisdistribution of similar sequences is particularly striking since, at thetime of this search, the public databases contained only 197 Ig H chainV region sequences from B-CLL patients (excluding those from ourlaboratories) out of a total of over 8,500H chain V region sequences(search of Entrez with terms “human immunoglobulin heavy chain variable”produced 8,874 hits in the nucleotide database and over 6,183 hits inthe protein database on Dec. 16, 2003).

Pairing restricted V_(L)J_(L) rearrangements with V segments in Sets.VLJL sequences corresponding to the shared V_(H)DJ_(H) of the 5 Setswere available for most of our B-CLL cases and for a few of thoseidentified in the public databases. Remarkably, the available IgV_(L)were highly conserved within Sets and the corresponding JL were veryrestricted (Table 1 and FIG. 2). Six of the eight Sets with available Lchains expressed the K isotype.

IgV gene mutation status and isotype restrictions of individual Sets.Most of the IgV_(H) sequences in each Set differed by <2.0% from themost similar germline gene, with the exception of Set II in which themedian level of mutation was 3.0%. Notably, the deduced proteinstructures in those sequences that were considered “mutated” using thetypical 2% threshold differed from the germline by relatively lowlevels. Only one sequence, from Set II (CLL ID47, FIG. 2), differed bymore than 5% from its germline counterpart. The corresponding IgV_(L) ineach Set exhibited low levels of mutation; in some cases V_(L) displayed<2.0% difference while V_(H) had >2% difference from the germlinesequence (Table 1 and FIG. 2).

The H chain isotype was the same among members of a Set. All Setsexpressed IgM, except for Set IV that consisted of IgG⁺ cases, similarto a patient group reported previously (Ghiotto et al., 2004).

H and L CDR3 characteristics of the individual Sets. We identifiedtrends in the chemical, structural, or functional nature of the residuesthat comprise the H and L CDR3s, and in particular their V_(H)-D andD-J_(H) junctions. For example, the D segments in the HCDR3s of theseSets were read in the hydrophobic and stop reading frames more oftenthan in normal (Zemlin et al., 2003) and B-CLL (Fais et al., 1999)cells. For all cases in Set VI, the D6-19 segment is read in anon-productive reading frame. However, the germline stop codon, locatedin the region of overlap with the terminal IgV_(H) sequence, wastrimmed, allowing productive rearrangements with the J_(H)4 segment(FIG. 8).

Also of note was the repeated occurrence of certain non-germline encodedamino acids within D segments in some of the Sets. For example in allmembers of Set VIII, a change to M is found at the 3′ end of the Dsegment (FIG. 5), a position that is not known to be polymorphic. Threeof 7 sequences in Set V had an R to Q change within the D3-10 segmentthat is also not listed as polymorphic (FIG. 6). In 4 of 5 cases in SetII, P replaced A in the portion of HCDR3 encoded by the canonical D5-5segment. While this is most likely a polymorphism of the D segmentrather than a common mutation, the last of the 5 sequences in this set(CLL ID47) also deviates from the canonical D5-5 sequence at this codon,substituting a D (FIG. 7). Thus even if these amino acid changesrepresent polymorphisms, their relative consistency within each Setsuggests a selection for these residues.

Members of several Sets have common junctional residues that were nottemplated by any known germline gene segments and therefore presumablyarose from trimming and/or addition during recombinational assembly. Thesequences in Set IV all contain a pair of Gs at the V_(H)-D junction andan N at the D-J_(H) junction (FIG. 4). A very similar V_(H)-D junctionalfinding exists in Set VIII (FIG. 5). All sequences in Set II contain anaromatic residue at the V_(H)-D and a pair of basic residues (R or K) atthe D-J_(H) junction (FIG. 7).

Other trends in the composition of the H and L CDR3s are found in theother Sets. These and the fine details of the nucleotide and amino acidsequences of the V_(H)DJ_(H) and V_(L)J_(L) junctions for each Set areshown and discussed in the Supplemental data (see FIGS. 4-8).

Structural similarities of the BCR among members of the Sets. Thededuced V_(H)DJ_(H) and V_(L)J_(L) protein sequences for each member ofthe stereotyped Sets are presented in FIGS. 2 and 3. Because mostmembers of the Sets use the same IgV_(H), primarily in an unmutatedform, associated with the same D and J_(H) segments and since theserearrangements are virtually always paired with an identical IgV_(L)that is restricted in its linked J_(L), the primary structural featuresof the entire BCR of each Set are likely remarkably similar.Furthermore, the amino acid sequences of HCDR1, HCDR2, LCDR 1, and LCDR2of members of the individual Sets are extremely similar, if notidentical (e.g., Sets IV, V, VIII, and the Set VI subsets). In Set IT,some amino acid differences exist in these regions due to somaticmutation.

These data indicate a much more marked constraint on the primarystructure of the BCR in B-CLL than previously appreciated. They alsoindicate that this principle occurs in a sizeable number of patients.Collectively, ˜12% (31 of 255: 22 from this study, 5 from our previousstudy (Ghiotto et al., 2004), and 4 that match another described set(Tobin et al., 2002; 2003)) of all of sequences in our internallaboratory B-CLL database and ˜20% (27 of 131) of those with unmutatedIgV belong to one of the eight stereotyped Sets described here or one ofthe two patient groups mentioned above (Tobin et al., 2002; 2003;Ghiotto et al., 2004). Approximately the same overall frequency (˜12%)was encountered among the sequences from the public databases (21 of197), although the proportion of the public B-CLL sequences that areunmutated was not determined. Most of the rearrangements in these Setslack or have few somatic mutations, and even those whose V_(H) surpassthe 2% threshold commonly used as the criterion to define significantIgV gene mutations (Fais et al., 1998; Schroeder and Dighiero et al.,1994) are only slightly above that level. This suggests that restrictedBCR structure is primarily a feature of those patients with the worseclinical course and outcome (Damle et al., 1999; Hamblin et al., 1999).It appears that 1 of 5 B-CLL cases with unmutated BCRs fit into one ofthese defined Sets. Additional Sets will likely be uncovered as more IgV region sequences are defined in B-CLL, and all unmutated cases may besimilar to one of a discrete number of archetypal Sets. Although SetsIV, V, VII, and VII use unmutated 1-69, they differ from previouslydescribed 1-69-expressing B-CLL cases that have restrictions in specificD and J_(H) segments associations (Fais et al., 1998; Johnson et al.,1997). These differences include J_(H) (J_(H)3 vs. J_(H)6 in Set I), D(D2 vs. D3 family and VκL6 with an extremely short LCDR3 in Set VIII),and L chain (λ vs. κ in Set V) gene use.

Initial studies that considered only IgV_(H) or V_(H)DJ_(H) (Fais etal., 1998; Schroeder and Dighiero, 1994; Johnson et al., 1997; Chiorazziand Ferrarini, 2001) pointed toward limited structural diversity in theantigen-binding sites of B-CLL. However, our results are much morestriking because of the remarkable similarity of the sequences within aSet and the virtual mathematic impossibility that this similarity aroseby chance. If gene segment use in B-CLL was random, the probability offinding the same combination of V_(H)DJ_(H) and V_(L)J_(L) segments inindependent leukemic (or normal) B cells would be >1×10⁻⁶. Therefore,one would not expect to identify two B-CLL patients with BCRs comprisedof the same V_(H)DJ_(H)/V_(L)J_(L) until >1 million cases were analyzed.This calculation is conservative since it does not account for diversityat the V_(H)-D, D-J_(H), and V_(L)-J_(L) junctions that can be quiteextensive (potentially exceeding 1×10⁻⁹ and reaching 1×10⁻¹²), althoughreceptor editing and revision could limit these possibilities somewhat.Nevertheless, the level and frequency of BCR structural restriction inclusters of patients reported here is extraordinary and appears to behigher than any other B or T cell lymphoproliferative disorder reportedto date.

Finding similar Ig H chain V region sequences by homology searches ofthe public databases is not, in itself, completely surprising becausesome IgV_(H) are expressed in a biased fashion and ˜6,600 differentV_(H)-D-J_(H) combinations can occur. Because the databases contain morethan that number of Ig H chain V region sequences, identifying the samerecombined gene segments is not improbable. When we analyzed 538 CD5⁺and CD5⁻ B cell-derived H chain V region sequences, we identified manypairs of similar sequences and some groups of similar sequences. Howeverthese groups derived from B cells of diverse sources, as would beexpected if the similarities were the product of random chance. Incontrast, the similarity to a given B-CLL-derived sequence detected inour database comparisons arose almost exclusively from other B-CLLsequences (19/21) or other lymphoproliferative disorders (1/21), eventhough the entire database was searched. Only one identified sequencewas from a non-B-CLL clone and that coded an autoantibody (Table I andFIG. 2). Although the proper normal B cell repertoire against whichB-CLL clones should be compared remains an open question (Chiorazzi andFerrarini, 2003), these results demonstrate that sequence sets ofrestricted cellular origin are not a generalized phenomenon in thepublic database.

Therefore, the development of B-CLL must involve B cell clones withrestricted IgV and/or BCR structure. While it seems unlikely that theexpression of particular BCR gene combinations could be the solepromoting factor for leukemogenesis, a strong inherent bias in genesegment association and V_(H)DJ_(H)/V_(L)J_(L) pairing in the B cellpopulation that gives rise to B-CLL cannot be formally excluded,especially since the cell of origin for B-CLL is still uncertain(Chiorazzi and Ferrarini, 2003). Although evidence exists in mice forbiases in the recombination of particular Ig V gene segments prior toantigen experience (Seidl et al., 1997), the extent of restrictionimposed by recombination biases at both the H and L chain V gene loci inthose instances, especially at the V-(D)-J junctions, are not as severeas in the Sets described here. To our knowledge, there is no knownsubpopulation of human B cells in which the frequency of similarrearrangements, independent of antigen selection, is as great as amongthese B-CLL cases.

Therefore, antigen selection probably has a strong restrictive influenceon the transformation of a normal B-lymphocyte to a B-CLL cell. A simplemodel would postulate that the transforming event is coupled withantigen specificity, i.e., an individual B-lymphocyte from a highlydiverse population could bind and internalize a transforming agent(e.g., virus) via its BCR. Although this seems unlikely, such amechanism has been implied for B-CLL (Mann et al., 1987).

Alternatively, antigen could be a promoting factor for transformation,selecting specific clones for expansion from an initially diversepopulation of B-lymphocytes and fostering their development to and inthe transformed state (Chiorazzi and Ferrarini, 2003). This would be thecase if the B-CLL-susceptible cell population were pre-selected forantigen-reactivity, and therefore BCR structure, by exposure to distinctantigens or classes of antigens during their development. These clonescould differ among patients, especially if the selecting antigens wereforeign or autologous and possibly polymorphic. From within these clonalexpansions, one member could develop an initial transforming lesion thatwould promulgate the leukemogenic cascade independent of antigen.

Finally, the initial transforming events could occur at random within adiverse B cell population or a previously antigen-selected population,and the subsequent nurturing of the transformed clone to clinical B-CLLcould require ongoing BCR engagement by antigen (Chiorazzi andFerrarini, 2003). Recently, clonal expansions of B cells with phenotypiccharacteristics of B-CLL were found in normal elderly individuals(Rawstron et al., 2002; Ghia et al., 2004. The clinical relevance ofthese clones is not established. However, they may represent clones thathave some of the genetic lesions of B-CLL but lack BCR specificitiesthat would result in sufficient ongoing stimulus to mature them intoclinical B-CLL.

The remarkable protein similarity of the entire BCR among members ofeach Set (FIGS. 2 and 3) suggests that they could recognize the same orsimilar antigens. While the nature of the antigen(s) cannot be directlydeduced from the Ig sequences presented here, there are several reasonsto suspect that they are autoantigens or carbohydrates possibly derivedfrom bacterial or viral coats, or a combination of the two.

V_(H)1-69 (Sets I, II, and III) and V_(H)3-21 (previously described Setin Tobin et al., 2002; 2003) are enriched among rheumatoid factors(Silverman et al., 1988; He et al., 1995). V_(H)4-34 (Set II) is used inevery case of monoclonal cold agglutinin disease (Pascual et al., 1992)and in autoimmune conditions. Indeed the inherent autoreactivity of thisV_(H) segment elicits a major inhibitory process by the immune systemthat keeps 4-34⁺ B cells from diversifying into high affinity,isotype-switched B cells (Pugh-Bernard et al., 2001). Theanti-cardiolipin antibody identified as a member of Set IV implies thatthe other members of that Set may be specific for cardiolipin or DNA,since some antibodies to the former react with the latter (Kumar et al.,2003). In addition, restricted V_(H)DJ_(H) and/or V_(L)J_(L) genesegments are features of B cells that produce anti-carbohydrate mAb inhuman (Scott et al., 1989) and mouse (Potter, 1977).

Characteristic junctional residues are also a feature ofanti-carbohydrate mAb and autoantibodies and basic junctional residues,as seen in Sets II, IV, and VIe (FIG. 2), often indicate reactivity withacidic targets such as DNA (Radic and Weigert, 1994). The synthesis ofautoreactive Ig/BCR molecules by many B-CLL clones (Sthoeger et al.,1989; Borche et al., 1990) supports a link between the unique BCRstructural features of these Sets and autoantibodies.

The non-B-CLL Ig sequences that matched these B-CLL stereotypes may giveinsight into the identity of the B-CLL progenitor cell(s). One of thosetwo derived from a splenic marginal zone lymphoma (SMZL; Set VIa, FIG.2) and the other from an autoantibody-producing B cell (Set IV, FIG. 2).Interestingly, normal MZ B cells produce mAb that can recognizethymus-independent type II antigens and autoantigens (Bendelac et al.,2001). In addition, the Ig V region repertoire of murine MZ B cells isvery restricted in gene segment use and structure that requires intactBCR signal transduction to develop (Martin and Kearnet, 2000). MZ Bcells appear to be progenitors for gastric MALT lymphoma (Isaacson,1999) and have been proposed as precursors of B-CLL cells (Chiorazzi andFerrarini, 2003). If one infers common antigenic reactivity based on thesimilar sequences within a Set, a significant fraction of B-CLL cases,and in particular those with unmutated IgV genes, produce mAb thatrecognize one of a limited, discrete array of antigens or epitopes. Withsuch an interpretation, some B-CLL cases may resemble gastric MALTlymphoma regarding the role of antigenic drive (in that instance, H.pylori) in the promotion of malignancy. The stereotyped Ig moleculesreported here might be valuable probes to identify antigens that drivethe leukemogenic process in B-CLL.

Finally, these Sets of stereotyped Ig molecules may serve as therapeutictargets on B-CLL cells. A conceptual drawback to targeting the BCR as atumor-specific antigen has been the apparent need to create anindividualized reagent for each patient. However, since our dataindicate that there is potentially extensive overlap in BCR structureand specificities among groups of B-CLL cases, this approach may be farless daunting. Indeed, since ˜20% of the cases with unmutated IgV_(H)genes fall into one of these Sets, such targeting might be mosteffective in those cases that have the worst prognosis, are leastresponsive to therapy, and have the most aggressive clinical courses(Damle et al., 1999; Hamblin et al., 1999).

In view of the above, it will be seen that the several advantages of theinvention are achieved and other advantages attained.

As various changes could be made in the above methods and compositionswithout departing from the scope of the invention, it is intended thatall matter contained in the above description and shown in theaccompanying drawings shall be interpreted as illustrative and not in alimiting sense.

All references cited in this specification are hereby incorporated byreference. The discussion of the references herein is intended merely tosummarize the assertions made by the authors and no admission is madethat any reference constitutes prior art. Applicants reserve the rightto challenge the accuracy and pertinence of the cited references.

What is claimed is:
 1. A method of (a) determining whether a patientwith B cell chronic lymphocytic leukemia (B-CLL) has a form of B-CLLsusceptible to treatment directed to eliminating idiotype-specific Bcell receptor-bearing B-CLL cells, or (b) following the progression oftreatment of B-CLL in a patient having a form of B-CLL susceptible totreatment directed to eliminating idiotype-specific B cellreceptor-bearing B-CLL cells, the method comprising determining whethera B cell receptors on a B-CLL from the patient is encoded by antibodygenes comprising a light chain antibody gene and a heavy chain antibodygene, wherein the light chain antibody gene and the heavy chain antibodygene are selected from the group consisting ofV_(H)4-34/D5-5/J_(H)6/V_(L)κA17/J_(L)κ1/κ2 (Set II),V_(H)3-21/J_(H)6/V_(L)λ3h/J_(L)λ3 (Set III),V_(H)1-69/D3-16/J_(H)3/V_(L)κA27/J_(L)κ1/κ4 (Set IV),V_(H)1-69/D3-10/J_(H)6/V_(L)λ1c/J_(L)λ1 (Set V),V_(H)1-02/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (Set VIa),V_(H)1-03/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (Set VIb),V_(H)1-18/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1 (Set VIc),V_(H)1-46/D6-19/J_(H)4 (Set VId),V_(H)5-51/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ2 (Set VIe),V_(H)1-69/D3-3/J_(H)4/V_(L)κA19/J_(L)κ4 (Set VII), andV_(H)1-69/D2-2/J_(H)6/V_(L)κL6/2/J_(L)κ3 (Set VIII), wherein if the Bcell receptor on the B-CLL cells has an idiotype encoded by the antibodygenes, the patient has a form of B-CLL susceptible to treatment directedto eliminating idiotype-specific B cell receptor-bearing B-CLL cells orthe treatment of the patient has not eliminated the idiotype-specific Bcell receptor-bearing B-CLL cells.
 2. The method of claim 1, fordetermining whether a patient with B cell chronic lymphocytic leukemia(B-CLL) has a form of B-CLL susceptible to treatment directed toeliminating idiotype-specific B cell receptor-bearing B-CLL cells. 3.The method of claim 1, for following the progression of treatment ofB-CLL in a patient having a form of B-CLL susceptible to treatmentdirected to eliminating idiotype-specific B cell receptor-bearing B-CLLcells.
 4. The method of claim 1, wherein the light chain antibody geneand the heavy chain antibody gene isV_(H)4-34/D5-5/J_(H)6/V_(L)κA17/J_(L)κ1/κ2 (Set II).
 5. The method ofclaim 1, wherein the light chain antibody gene and the heavy chainantibody gene is V_(H)3-21/J_(H)6/V_(L)λ3h/J_(L)λ3 (Set III).
 6. Themethod of claim 1, wherein the light chain antibody gene and the heavychain antibody gene is V_(H)1-69/D3-16/J_(H)3/V_(L)κA27/J_(L)κ1/κ4 (SetIV).
 7. The method of claim 1, wherein the light chain antibody gene andthe heavy chain antibody gene is V_(H)1-69/D3-10/J_(H)6/V_(L)λ1c/V_(L)λ1(Set V).
 8. The method of claim 1, wherein the light chain antibody geneand the heavy chain antibody gene isV_(H)1-02/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (Set VIa).
 9. The methodof claim 1, wherein the light chain antibody gene and the heavy chainantibody gene is V_(H)1-03/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ1/κ2 (SetVIb).
 10. The method of claim 1, wherein the light chain antibody geneand the heavy chain antibody gene isV_(H)1-18/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ4 (Set VIc).
 11. The method ofclaim 1, wherein the light chain antibody gene and the heavy chainantibody gene is V_(H)1-46/D6-19/J_(H)4 (Set VId).
 12. The method ofclaim 1, wherein the light chain antibody gene and the heavy chainantibody gene is V_(H)5-51/D6-19/J_(H)4/V_(L)κO12/2/J_(L)κ2 (Set VIe).13. The method of claim 1, wherein the light chain antibody gene and theheavy chain antibody gene is V_(H)1-69/D3-3/J_(H)4/V_(L)κA19/J_(L)κ4(Set VII).
 14. The method of claim 1, wherein the light chain antibodygene and the heavy chain antibody gene isV_(H)1-69/D2-2/J_(H)6/V_(L)κL6/2/J_(L)κ3 (Set VIII).
 15. The method ofclaim 1, wherein the patient is pre-leukemic.
 16. The method of claim 1,wherein the patient is in an early leukemic state.
 17. The method ofclaim 1, wherein the patient is in a frank leukemic state.
 18. Themethod of claim 1, wherein the B-CLL cells from blood of the patient areevaluated.